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A faulty production line

Cheer of home visits has become a chore

Dr Zoe Norris

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I have finally written a thing I never thought I would need: a home visiting protocol. Why? Because the thing I loved the most as a medical student has turned into a pet hate.

The joy used to be that you could go to see people just because they were lonely, or to check up on them before they became ill. (Isn’t that called preventive medicine?). You also had colleagues to work with in the community – the district nurses were easy to chat to because they were in the surgery too. You didn’t spend half an hour trying to find which form to fill in because there weren’t any forms – what nirvana!

I recall fondly my first GP attachment at medical school. It was in a small, terribly well-to-do practice somewhere in rural Nottinghamshire and I was bored to tears. The brief respites were the home visits.

The GP was a ‘proper’ doctor – male, mid-50s, white, nice two-seater sports car. He ticked all the boxes, and arrived in his impeccable suit with leather bag in hand.

Home visits gave me a way to nose round other peoples' homes without being arrested

I trailed behind looking awkward in my one pair of smart trousers from New Look and a creased jumper rescued from the wash that morning.

He was greeted like an old friend, offered tea, biscuits, and not infrequently lunch, by all the patients. There was little medicine, and a lot of chatting. It was fascinating in a way that the surgery wasn’t; I had found a legitimate route to nosing around other people’s homes without being arrested. General practice had it nailed.

But at some point, time pressures grew and only poorly people got home visits. Even then not all of them were acutely ill, some were still chronic disease patients or the frail elderly. Now workload is so bad I have time for one, maybe two visits max.

Yet home visit requests now flood in from other health providers wanting us to take up their slack. Why am I being called to review the palliative patient in the nursing home? Has anything changed, are they distressed, is the family worried? ‘No doctor, but we weren’t sure if they were palliative or about to die…’ And it just keeps increasing: discharged from hospital – home visit; rung 111 – home visit; can’t get a taxi – home visit.

Perhaps it is that the number of cups of tea I’m offered has fallen as demand has risen, but there seems to be no appreciation from the system, or from the patients, about how this once-cherished service is now being abused.

So I have written the protocol to try to educate patients about the harsh reality of general practice in 2018. Will it solve the problem for me? No chance, because again it’s about me having to say ‘no’ to patients.

I didn’t become a GP to ration care – we’re a band of eager puppies who want everyone to like us.

And let’s be honest, this is another nail in the coffin of the ‘jewel in the crown’ of the NHS (along with the three-week waits and ever-decreasing staff). When the NHS dissolves into private practice, maybe I’ll regain my joy about home visits.

Perhaps I need the awfully nice folks to fawn over me with tea and biscuits to feel valued. Or maybe I just need time to do my job – now there’s a radical thought.

Dr Zoe Norris is a GP in Hull 

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Readers' comments (18)

  • Home visits were one of the reasons that I left the UK.
    “I paid my taxes and I am entitled to a home visit”
    Does this pethatic phrase ring a bell?
    I have done 3 home visits in 3 years and all of them were out of choice , I could have easily said no sorry I don’t do visits .

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  • David Banner

    The concept of squeezing visits between 2 surgeries has always been ludicrous. It’s amazing how tolerant some GPs are of this destruction of their “lunch hour”, visiting on request without question, whilst others rightly triage them down to a few palliative care calls. Curbing the culture of visits is a vital survival strategy, and no right minded young GP would join a practice that did house calls on demand.

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  • Welcome to demographic shift.
    Be grateful that you had those good times in general practice. They'd pretty much dried up by the time I was a medical student and things were certainly not better when I was training.
    Any service that is free at point of use rations on time and availability.

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  • home visit was my nightmare all my working life. I still work but do no home visits. on Ist april 1988 my staff put 7 home visit as a joke and I blew my top off as they knew how much I hated home visits.
    I had a gust a senior nurse from Newzeland who told me her gp practice did one home visit in 34 years and that was deemed unnecessary. after doing 3 hours stint in surgery one wants a bit od peace, not lumbered with 2 or 3 home visits.
    oph are the worst culprit. in 1980's I did hundred of visits for child's colds and cough. not doing would generate complaint and even if it is not genuine LMC will ask you to attend complaint procedure.
    I remember doing home visit for threadworm. mother said she can't pick up rx. patients goes to football match but expect home visit for skin rash. yes abuse ab=use abuse of home visit. charge £100 for home visits.

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  • “A legitimate route to nosing around other people’s homes without being arrested”... Spot on, Zoë! How this phrase made me laugh... And hearing their stories, most of them fascinating. And sometimes a bit of medicine thrown in. But yes, that was then. Now it’s just another timewasting burden.

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  • My favourite home visit was on a Saturday at midday . On arrival , her husband apologised that his wife had gone out . She was now in the hairdressers three miles away . The hairdressers was - next door to my surgery !

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  • I have done about 3 home visits in 3 years, scheduled as part of surgery time. Patients here seem to be able to get in to the surgery and some of them live 20-30 miles away in a very rural part of New Zealand down variable roads subject to landslips. I haven't noticed lots of bodies littering the streets.

    Perhaps visits aren't quite as essential as some seem to think.

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  • @Jonathan Jones
    No surprise there. The hairdresser costs £ but you’re free! Guess who’s more important!

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